Although it’s frequently overshadowed by more seemingly impactful symptoms like pain, nausea and sensitivity to light and sound, fatigue is a hallmark symptom of Migraine Disease.

According to a research study that asked patients to keep electronic diaries about their attacks, about 72% of Migraine patients who experience premonitory symptoms that alert them a Migraine attack is on the way experience fatigue. Fatigue is a state of extreme tiredness, weakness and exhaustion that can manifest itself either physically or mentally or both.

Fatigue among Migraine patients can be incredibly insidious because many of us experience it during most phases of the Migraine attack: Before the attack during the prodome phase, during the attack and after the attack during the postdome phase. And it’s even more burdensome for those living with Chronic Migraine, who often end up experiencing nearly constant fatigue. By one estimate 67% of people with Chronic Migraine meet the criteria for a diagnosis of Chronic Fatigue Syndrome.

Coping with high levels of fatigue, especially when you experience it frequently, is difficult. Here are a few strategies than can help:

It may seem tempting to attribute Migraine-related fatigue to the burden of the pain and other symptoms associated with Migraine attacks, but it’s highly possible fatigue is related to the pathophysiology of Migraine (the disease process itself). It could be that fatigue is caused by the extreme neurological disruption involved in a migraine attack. Researchers don’t yet have confirmation of this, but as they learn more about the pathophysiology of Migraine, they come closer to being able to find out.